Protecting the most vulnerable from measles

What a growing measles outbreak means for those with cancer and others who can’t get the vaccine
Dr. Jeffrey Gunzenhauser,
Dr. Jeffrey Gunzenhauser, Los Angeles County Department of Public Health interim health officer, speaks about the state's measles outbreak during a news conference on Feb. 4, 2015. That same day, California lawmakers said they would introduce legislation requiring all school kids to be vaccinated unless there are medical reasons prohibiting it. Photo by Nick Ut / AP

Dr. Steven Pergam remembers his parents recounting their dread when they were young and would hear about a neighborhood child spiking a high fever or becoming unexpectedly ill. It was a time before the vaccines for polio and other illnesses were widely available and the stakes were incredibly high.

“They saw people die, and they saw children suffering from complications of disease,” said Pergam, infectious disease researcher at Fred Hutchinson Cancer Research Center. “When vaccines became available, it was a big relief. Today, we tend to forget how bad these [communicable] illnesses can be, and we start to think the risks are low.”

Polio was eradicated in the U.S., thanks to vaccination. And, in 2000, measles was considered to have been eliminated in the U.S. as well. But now, as has been widely reported, we’re in the midst of an outbreak that has led to more than 100 people being diagnosed in 14 states since December when visitors to Disneyland began coming down with measles.

“This is an example of what can happen when kids and families get together [and there are unvaccinated people in the group],” said Pergam, who directs infection control at Seattle Cancer Care Alliance.

A growing number of parents are choosing to not have their children vaccinated for measles and other preventable diseases. However, some groups don’t have the option, such as infants under 6 months who are too young for the shot, some cancer patients and those who are immunosuppressed. 

Those who have had a stem cell transplant typically lose the protection they'd acquired through prior vaccinations and need to be revaccinated, usually starting six months or a year after the transplant. But they can't be given some vaccinations using a live virus for a longer period of time. Meanwhile, they are especially vulnerable until their immune sytems become stronger.    

“Bone marrow transplant patients, for example, cannot get the measles, mumps, and rubella (MMR) vaccine until at least two years after the procedure, and are therefore at high risk for developing life-threatening complications from measles,” said Pergam.

Fred Hutch and SCCA see approximately 500 transplant patients each year. “And we are not the only transplant center in the country,” Pegram said, “there are plenty of others.”

Many of these patients are at risk for measles if they encounter an unvaccinated person who has become infected. In order to protect the most vulnerable among us, Pergam said, the healthy need to be vaccinated. 

Carl Krawitt, the California father of a 6-year-old boy with leukemia, is on a campaign to have immunization required at schools, with the exception of those who cannot get a vaccine for medical reasons, like his son, according to the blog The California Report.

In Washington state, Rep. June Robinson introduced a bill on Wednesday that would limit vaccine exemptions for personal beliefs. That same day, California lawmakers also said they would introduce legislation requiring all school kids to be vaccinated unless there are medical reasons prohibiting it.    

 “It’s very emotional for me,” Krawitt told The California Report. “If you choose not to immunize your own child and your own child dies because they get measles, OK, that’s your responsibility, that’s your choice. But if your child gets sick and gets my child sick and my child dies, then … your action has harmed my child.”

Measles on the move

A person with measles can spread the disease to others for about eight days – the contagious period begins approximately four days before any symptoms appear and can continue four days after a rash develops. When measles strikes, it brings a fever, dry cough, runny nose, teary eyes, and the classic, spotty red rash. “Koplik spots” – blue-white spots on a red background – may be seen in the mouth before any other symptoms are noticed.

Once contracted, measles can lead to severe health complications, such as pneumonia, diarrhea, brain damage and blindness. Even with excellent medical care, death can occur in as many as 1 to 3 of every thousand cases.

“Measles is one of the most transmittable diseases out there,” said Pergam. The virus travels via respiratory droplets – tiny saliva specks – that disperse through the air when a person coughs, sneezes, or even talks, making extreme isolation the only way to prevent passing it on. Infected droplets can also remain contagious for several hours on surfaces such as doorknobs, tables, cellphones and keyboards. An unvaccinated person can be exposed by just entering a room where an infected person had been a few hours before.

The need for herd immunity

Today, measles is easily prevented through the MMR vaccine. This is a live-virus immunization, which means the shot contains a very small amount of an attenuated virus. “This is a weakened virus,” said Pergam, “and for normal, healthy people it’s not a problem.”

However, the risks only become and remain low if everyone takes advantage of immunization and contributes to what is called “herd immunity.” The concept is simple but powerful, says Pergam. “The more people are immunized, each time the virus tries to make a jump to another person its spread is limited.” In essence, vaccinated people act like a brick wall to measles – the disease cannot move through them to infect others.

Not everyone is on board with immunizations, however. Today’s anti-vaccine trend can be traced to a research paper that was published in 1998 in The Lancet, a British medical journal. The lead author of that study suggested that vaccines, specifically the MMR vaccine, could cause autism.

The article received broad media attention, but was retracted in 2010 after years of investigation found no relationship between the MMR vaccine and autism. Unfortunately, the damage had already been done. Following the appearance of the paper, MMR vaccination rates in the United Kingdom fell sharply, and the incidence of measles rose.              

The CDC notes that, since that time, 10 of the 13 authors of The Lancet article have withdrawn their support of the research. In addition, according to the CDC, more than 20 studies using a variety of methods have found no links between the MMR vaccine and autism.

The fear of immunization continues, but Pergam is hopeful that the tide will turn. “Particularly if you are on the fence about having your child immunized, this is the time to really rethink it and to talk to your pediatrician. The best way to stop the measles in the US is to get people vaccinated. There is no other way we can do this.”

Measles facts:

  • Measles is preventable, and the disease can only spread to people who have not been immunized.
  • The MMR vaccine is recommended for children ages 12 months to 15 months, with a second dose before kindergarten. Delaying the first dose of vaccine extends a child’s risk of contracting measles, mumps or rubella.
  • Before traveling outside the United States, infants age 6 to 12 months need to receive one dose of measles vaccine. Children 12 months and older need two doses. Talk to your pediatrician before taking a trip.
  • Measles is much more dangerous to those who are immunocompromised and therefore (technically or otherwise) unvaccinated – this includes people undergoing solid organ transplant or bone marrow transplant, and other people taking immunosuppressive drugs (such as those with HIV).
  • If you are in doubt about your own MMR status, talk to your healthcare provider.
  • According to Pergam, medical conditions that would prevent measles vaccination are uncommon. Currently the MMR shot is not recommended for little ones less than 6 months old, pregnant women, people taking immunosuppressive medications, and anyone allergic to a component of the vaccine (very rare).

Joely Johnson Mork is a Seattle-based freelance health and science writer/editor whose work has appeared in numerous consumer health books, as well as in Prevention and TIME. Her personal essays have been heard on NPR. Mork has a master’s degree in community health education and is a certified yoga instructor. Reach her at

Related News

All news
When a cold can kill: Cancer, transplant patients at risk from ordinary infections Flu shots, hand hygiene and a healthy fear of public germs can help keep them safe during recovery, experts say October 21, 2014
Dual diagnoses: Father and daughter share journey through cancer Louisa Cryan had leukemia at the age of 12; a few years later, her dad faced his own cancer diagnosis June 13, 2014
Why the flu hit hardest in middle-aged adults last year Previous influenza infections in childhood may be the culprit, study finds October 20, 2014

Help Us Eliminate Cancer

Every dollar counts. Please support lifesaving research today.